Policy: Health Care

Military family’s appeal to Congress backfires after DOD denies coverage for disabled girl’s therapy

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Politics,Beltway Confidential,Congress,Joel Gehrke,The Pentagon,Health Care

A military family’s campaign to have Congress restore health insurance coverage for a therapy administered to the disabled daughter of a Navy pilot backfired when a group of lawmakers in the House of Representatives recommended legislative text that the family regards as detrimental to their cause.

“After working so hard and overcoming so many obstacles in order to get Kaitlyn’s Law to Congress, it is unconscionable that we now have revised language that could actually harm military families,” said Mike Hogg, a retired Navy chaplain and executive director of Rocky Top Therapy Services.

Fifteen-year-old Kaitlyn Samuels has cerebral palsy and scoliosis. Because her dad is a Navy pilot, her health insurance comes through Tricare, a Defense Department program. At Rocky Top Therapy Services, her physical therapy exercises have been done on a horse.

The horse is necessary because Kaitlyn has the mental capacity of a toddler and is too easily disengaged unless the horse is involved. (DOD is willing to pay for therapy in a conventional setting, even though that therapy costs $300 per 30-minute session, compared to just $80 per 30-minute session for the therapy she receives at Rocky Top.)

When DOD decided to stop covering Kaitlyn’s horse treatment because it is considered experimental, the Samuels family appealed to Congress to insert language into the upcoming National Defense Authorization Act to require Tricare to resume paying for the process.

“For my daughter, this therapy means life, death or some horrible surgery, but she’s not alone — there are 27 other military families who use the center where Kaitlyn goes,” Jennifer Samuels told Military Times.

Rep. Michael Burgess, R-Texas, sponsored the resulting measure — the Samuels family lives in his district — but a House Armed Services subcommittee adopted a different language when it marked up the NDAA.

“It’s not something that’s covered by large insurers anywhere in the country and it is commonly considered experimental, for better or for worse,” House Armed Services Committee spokesman Claude Chafin told The Washington Examiner.

“[DOD sees] Tricare as a medical insurance company, and they use the insurance community as an industry standard they should match,” Chafin said.

Rocky Top Therapy’s Hogg said the committee has the facts wrong. “Several big private insurers cover this kind of life-saving therapy with no problem,” he told The Examiner. “It is a tragedy that our government, through Tricare, won’t measure up to the same standards and make sure that kids with special needs and wounded warriors get the care they deserve.”

Chafin said the subcommittee’s language directs Tricare to review whether the law allows coverage of the treatment or to provide alternative coverage through the Extended Care Health Option. The study must be completed by April 2014 if the subcommittee’s language becomes law.

Samuels family advocates regard that development as detrimental to their cause. “The current language will actually harm Wounded Warriors and special needs kids like Kaitlyn who rely on this kind of therapy for their very survival,” Karen Golden, deputy director of military family issues at the Military Officers Association of America, said in a statement last week following the markup.

Chafin disagreed. “The committee believes we’re taking up a responsible position to meet the needs of military families who have special-needs family members,” he said in the interview. “The intent of this legislation is to have DOD take a second look at the decisions they have made and give us a report on the feasibility of including this in the ECHO program.”

“The language as written could have unintended consequences,” Golden told The Examiner, saying that “by exploring putting this benefit –or a piece of this benefit — into the ECHO program, the unintended consequence is that you could be excluding a group of beneficiaries.” Golden explained that the ECHO program only covers a subset of active duty service members.

DOD offered ECHO as a possible source of coverage for Kaitlyn before the legislative push began. “The administrative appeal rights have now been exhausted,” Army Brig. Gen. W. Bryan Gamble replied in February 2013 to Jennifer Samuels after she wrote to President Obama requesting that Tricare adhere to the judge’s ruling.

Gamble said that the administrative judge’s ruling was incorrect, saying that the therapy Kaitlyn received was “hippotherapy, (a form of exercise or therapeutic horseback riding), as opposed to physical therapy.” The general told Samuels that DOD is “exploring whether there is any alternative outside of the TRICARE Basic Program that would permit us legally to pay for hippotherapy in the future.”

He suggested she visit the ECHO program website for more information.

Chafin said that the subcommittee discarded the language Burgess originally sponsored after consulting with DOD officials. “As with most parts of building the NDAA, there is a close collaborative effort with the department,” Chafin said. “It doesn’t mean we always do what they want us to do, but we go to great lengths, when writing report language or legislative language, [to ensure] that the department will interpret it the way we intend them to interpret it.”

This outcome frustrated some proponents of Kaitlyn’s Law. “I think the family was hopeful that Congressman Burgess would, I don’t know, slug it out, stand up, be a little more forceful, a little more assertive, and hold the original intent or the original wording of the bill to where it has some teeth in it,” Hogg told The Washington Examiner.

A House Republican aide familiar with the issue said Burgess can still deliver the original language, especially because there is some support for the Kaitlyn’s Law on the Senate side.

“He can either ask that [the new language] be removed or he can work through the process to get to a place that’s even more acceptable to all,” said the aide, who requested anonymity. “Either way, he’s best suited to make something happen.”

Burgess could also “deputize” someone on the House Armed Services Committee to push for Kaitlyn’s Law on his behalf, the aide said. But Kaitlyn’s Law won’t pass if Burgess supports the language reported out of the subcommittee markup.

The Samuels family is feeling optimistic after an in-person meeting with Burgess in Texas on Friday of last week.

“Very thankful to Congressman Dr. Michael Burgess for giving us so much of his time and listening and understanding what we wanted to explain,” Jennifer Samuels wrote in a Facebook post following the meeting. “Feeling good that by the end of the entire political process Kaitlyn’s Law will help many military families and Wounded Warriors.”

Video report on Kaitlyn Samuels by KTVT-TV, Dallas/Fort Worth's CBS affiliate
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